Thursday, October 27, 2011

A Note on Trigeminal Neuralgia with no Apparent Organic Cause

Trigeminal Neuralgia with no Apparent Organic Cause

Such conditions have many names: idiopathic trigeminal neuralgia, trigeminal neuralgia, benign paroxysmal trigeminal neuralgia, tic doloureux.
Trigeminal neuralgia is the most common neurological cause of orofacial pain. It is, however, rare and seen mainly in middle-aged or older patients.
The cause is unclear, but trigeminal neuralgia may be due to an atherosclerotic blood vessel pressing on the roots of the trigeminal nerve.
Clinical Features
Trigeminal neuralgia has the following main characteristics.
Pain which is:
  •  severe;
  •  of abrupt onset and termination;
  •  electric shock-like, brief, stabbing (lancinating);
  •  unilateral;
  •  restricted to the trigeminal nerve distribution.
The pain usually involves the mandibular and, rarely, the other divisions of the trigeminal nerve. In some patients the pain is triggered. The trigger site may bear no relation to the painful area, but is always ipsilateral to the pain. Patients do not necessarily recognize the trigger for what it is, and may find that pain is brought on by chewing, talking, swallowing, smiling or temperature changeóusually exposure to cold air.
Pain-free Intervals Between Attacks
This is often an intermittent disease, with apparent remissions for months or years. However, recurrence is common. Very often the pain spreads to involve a wider area over time and the intervals between episodes tend to shorten.
Lack of Neurological Abnormality
There is no sensory loss in the trigeminal region; nor are other neurological abnormalities present. Neurological assessment is needed because similar pain is secondary to multiple sclerosis, tumours, neurosyphilis, HIV infection and other lesions.
Diagnosis and Management
Patients with trigeminal neuralgia are ideally seen at an early stage by a specialist in order to confirm the diagnosis and initiate treatment

Roles of the dental clinical team in the management of a patient with trigeminal neuralgia
Dental surgeon
Ancillary, Hygienist, Nurse
Refer to specialist. Understand disease and
management in order to extend education of, and reassure, patient

Alert specialist to any possible adverse
effects of treatment

Oral healthcare; in particular to avoid
causes of pain

Oral health education of patient

Avoid any trigger zones

Avoid drug interactions with carbamazepine
or other agents
Understand disease and management in order to
extend education of, and reassure, patient

Oral health education of patient

Avoid any trigger zones

Alert dental surgeon to any changes, or possible
adverse effects of treatment

Patient information sheet: trigeminal neuralgia
This is an uncommon disorder

The cause is unknown but involves spontaneous activity of pain nerves

It is not inherited

It is not known to be infectious

Similar symptoms may be seen in some neurological conditions (which we will exclude)

There are usually no long-term consequences

X-rays and blood tests may be required

Symptoms may be controlled but not cured by drugs with an anticonvulsant action

Uncontrolled pain may be treated by freezing the nerve, or by surgery

Medical treatment, typically using anticonvulsants, is successful for most patients. Carbamazepine (Tegretol) is still the main agent used. It must be given continuously prophylactically for long periods. However, it is not an analgesic and, if given when an attack starts, will not relieve the pain.
Carbamazepine must be used carefully and under strict medical surveillance because it can have a range of adverse effects, particularly affecting balance, blood cells, blood pressure and liver function. Typically, the dose is increased to try to control the pain while at the same time trying to avoid ataxia and other adverse effects. If carbamazepine fails, phenytoin or baclofen or other drugs are occasionally useful.
If medical treatment fails or the adverse drug effects are too pronounced, surgery may be required. Injections of local analgesic will temporarily block the pain. Local cryosurgery to the trigeminal nerve branches involved (cryoanalgesia) can produce analgesia without permanent anaesthesia, but the benefit can usually be measured only in months rather than years.
For intractable cases neurosurgery, such as destruction of the trigeminal ganglion (radiofrequency ganglionolysis) or decompression of the trigeminal nerve, may be required. Unfortunately, pain is exchanged for anaesthesia and risk of damage to the cornea and, occasionally, continuous anaesthesia but with pain (anaesthesia dolorosa).

Trigeminal Neuralgia ppt 1

Trigeminal Neuralgia ppt 2

Trigeminal Neuralgia....A Video

Download PPT 1  and PPT 2


  1. Concise and to the point. 5 stars

  2. Hello, I was very encouraged to find this site. The reason being that this is such an informative post.
    dental care chicago

  3. Am Richard, I am here to testify about a great herbalist  man who cured my wife of breast cancer. His name is Dr Imoloa. My wife went through this pain for 3 years, i almost spent all i had, until i saw some testimonies online on how Dr. Imoloa cure them from their diseases, immediately i contacted him through. then he told me the necessary things to do before he will send  the herbal medicine. Wish he did through DHL courier service, And he instructed us on how to apply or drink the medicine for good two weeks. and to greatest surprise before the upper third week my wife was relief from all the pains, Believe me, that was how my wife was cured from breast cancer by this great man. He also have powerful herbal medicine to cure diseases like: Alzheimer's disease, parkinson's disease, vaginal cancer, epilepsy Anxiety Disorders, Autoimmune Disease, Back Pain, Back Sprain, Bipolar Disorder, Brain Tumor, Malignant, Bruxism, Bulimia, Cervical Disc Disease, Cardiovascular Disease, Neoplasms , chronic respiratory disease, mental and behavioral disorder, Cystic Fibrosis, Hypertension, Diabetes, Asthma, Autoimmune inflammatory media arthritis ed. chronic kidney disease, inflammatory joint disease, impotence, alcohol spectrum feta, dysthymic disorder, eczema, tuberculosis, chronic fatigue syndrome, constipation, inflammatory bowel disease, lupus disease, mouth ulcer, mouth cancer, body pain, fever, hepatitis ABC, syphilis, diarrhea, HIV / AIDS, Huntington's disease, back acne, chronic kidney failure, addison's disease, chronic pain, Crohn's pain, cystic fibrosis, fibromyalgia, inflammatory Bowel disease, fungal nail disease, Lyme disease, Celia disease, Lymphoma, Major depression, Malignant melanoma, Mania, Melorheostosis, Meniere's disease, Mucopolysaccharidosis, Multiple sclerosis, Muscular dystrophy, Rheumatoid arthritis. You can reach him Email Via / whatsapp +2347081986098    Website/



+1 this blog

you might also like

Related Posts Plugin for WordPress, Blogger...